Eastern equine encephalitis, also known as EEE or triple E, is a rare mosquito-borne viral disease that has killed at least two people and sickened 11 others in the United States this year. The deadly virus, which is circulating in the Northeast, is stoking fears about outbreaks and putting some communities on high alert.
The EEE virus is spread to people through the bite of an infected mosquito, according to the U.S. Centers for Disease Control and Prevention. In humans, the EEE virus can attack the central nervous system and cause swelling and brain damage. About one-third of people with EEE will die.
Mosquito season is not over yet in the U.S., and activity can continue as late as November in some states.
“EEE risk does not end on Labor Day,” said Dr. Catherine M. Brown, Massachusetts’ state epidemiologist, in a statement.
Here’s what to know as the triple E virus continues to spread:
EEE outbreak 2024
The U.S. is currently experiencing an outbreak of the triple E virus in the Northeast. At least seven states have confirmed human cases of eastern equine encephalitis so far this year. The majority of EEE activity in the U.S. this summer has occurred in Massachusetts, but cases have also been reported in New Hampshire, New York, New Jersey, Vermont, Rhode Island and Wisconsin.
EEE in New York
On Monday, Governor Kathy Hochul announced that a New York resident had died from eastern equine encephalitis. The case, which was confirmed in Ulster County on Sept. 20, was the first human case of EEE in New York in a decade, state health department officials said in a release.
The news comes less than a month after New Hampshire officials announced the death of a healthy 41-year-old man from the virus. Cases have also been reported in at least five other states.
The state issued a “Declaration of an Imminent Threat to Public Health for EEE” on Sept. 23, which unlocks state resources to prevent EEE transmission, including mosquito spraying efforts through November, the governor’s office said in a press release.
EEE in Massachusetts
On Sept. 9, the Massachusetts Department of Public Health confirmed the state’s fourth human case of EEE this year. Two cases were reported in Middlesex County, one in Worcester County, and one in Plymouth County.
There have been at least 95 samples from mosquitos that were positive for EEE and two horse cases in Massachusetts this year so far, officials said in a press release. Currently, 14 towns across the state are considered to be at either critical or high risk for EEE.
“We have not seen an outbreak of EEE for four years in Massachusetts,” the state’s health commissioner, Dr. Robbie Goldstein, said in a press release.
As of Sep. 24, 13 towns in Massachusetts are considered to be at high risk, which means conditions will likely lead to an EEE case, per state data. Four towns in Worcester County are at “critical risk,” which means there’s excessive risk from the EEE virus because a person has tested positive in the area.
What is the disease EEE?
EEE stands for eastern equine encephalitis, a rare but life-threatening infection caused by the eastern equine encephalitis virus, which can infect mosquitoes, humans and a range of animals, according to the U.S. Centers for Disease Control and Prevention. The virus is found in North America and the Caribbean.
In humans, the virus can affect the central nervous system, namely the brain and spinal cord, and cause severe disease or death.
There are typically only a handful of human cases of eastern equine encephalitis in the U.S. each year, but annual case count can vary, according to the CDC.
“You’ll see a couple of cases each year, then some years have explosive outbreaks, where everything comes together — the mosquitoes, the birds, the migration, the bird immunity — and you’ll see dozens and dozens of cases,” Dr. Daniel Pastula, chief of neuro-infectious diseases and global neurology at the University of Colorado School of Medicine, tells TODAY.com.
There were seven cases the U.S. in 2023, one in 2021, and 13 cases in 2020. In 2019, the U.S. saw 38 cases, the highest annual count in over a decade.
Most cases are reported from July through October, says Pastula. Infections peak during the summer months during mosquito season, but cases can continue into the fall depending on the region and climate, per the Cleveland Clinic.
What is the EEE mortality rate?
About 30% of people with eastern equine encephalitis will die, as the infection can cause inflammation and swelling of the brain, Pastula says. Survivors often suffer from lasting neurological problems, per the CDC.
How does eastern equine encephalitis spread to humans?
In nature, the eastern equine encephalitis virus is maintained through a transmission cycle between mosquitoes — specifically, the species Culiseta melanura or the “black-legged mosquito” — living freshwater hardwood swamps and wild birds, which are reservoirs for the virus, Pastula notes.
Because this species of mosquito primarily feeds on birds, they are not a main vector of the virus to humans, per the CDC.
Eastern equine encephalitis virus transmits to people when another mosquito species which feeds on humans and birds (such as the Culex mosquito, which also spreads West Nile) becomes infected and creates a “bridge” between the infected birds and uninfected people or animals, says Pastula.
Humans are considered “dead-end hosts.” Eastern equine encephalitis cannot spread from human to human or from horse to human.
There have been rare human cases of eastern equine encephalitis transmitted through organ transplantation, Pastula notes.
Signs of EEE in humans
Most people who become infected with eastern equine encephalitis develop no symptoms.
For those who do, symptoms of EEE include:
FeverChillsMuscle achesJoint pain
These typically last for one to two weeks, and most people will recover completely if the central nervous system is not affected by the virus, according to the CDC.
“In about 5% of infections, people can get a very severe encephalitis,” says Pastula.
A severe infection with eastern equine encephalitis can cause neurological disease, which may lead to inflammation of the brain (encephalitis) or the tissues around the brain and spinal cord (meningitis).
According to the CDC, symptoms of severe eastern equine encephalitis include:
High feverBehavioral changesSeizuresVomitingDiarrheaComa
These complications can become life-threatening, and about one in three people with eastern equine encephalitis will die. Many people who recover are left with long-term mental and physical problems, including intellectual disabilities, seizures or personality disorders, per the CDC.
The age groups most affected by severe infections are children under the age of 15 and adults over the age of 50, says Pastula.
Incubation period for EEE
If EEE symptoms do occur, these typically begin within four to 10 days after being bitten by an infected mosquito, per the CDC. According to the Massachusetts health department, they can also start as early as three days after getting bitten.
Where is EEE found in the U.S.?
In the U.S., eastern equine encephalitis cases are most often found in states on the Eastern seaboard, in the Gulf Coast, and near the Great Lakes, says Pastula.
Transmission is most common in and around bodies of freshwater and swamps, according to the Cleveland Clinic.
Between 2003 and 2023, there were at least 196 human cases of EEE reported in the U.S., mainly in states on the Atlantic coast, per historical CDC data.
EEE virus map of US in 2024
Eastern equine encephalitis virus human disease cases reported by state of residence, 2024.CDC
Per CDC data as of Sep. 17, as well as data from the New York State Health Department, there have been at least 11 human cases of eastern equine encephalitis reported in the U.S. this year. All 11 cases were the more severe (neuroinvasive) form of the disease. These cases have been reported in seven states:
Massachusetts New HampshireNew JerseyNew YorkRhode IslandVermontWisconsin
So far this year, Massachusetts has reported the largest number of human EEE cases, four.
Cases may increase as mosquito season continues and CDC data is updated with reports from state or local health departments.
EEE virus treatment
There is no cure or specific treatment for eastern equine encephalitis. Antibiotics are not effective, as the infection is caused by a virus.
Treatment is often focused on alleviating symptoms, and such as rest, fluids to prevent dehydration and over-the-counter pain relievers, per the Cleveland Clinic.
Severe cases of eastern equine encephalitis may be managed in the hospital and require additional monitoring and supportive care.
How to prevent eastern equine encephalitis
There is no vaccine to protect against eastern equine encephalitis. Protecting yourself from mosquito bites is the best way to lower your risk of eastern equine encephalitis and other diseases spread by mosquitoes, Pastula notes.
You can take the following actions to prevent mosquito bites, according to the CDC:
Apply an EPA-registered insect repellentWear long sleeve shirts and pants outside Limit outdoor activities from dusk to dawn, when mosquitoes are most activeUse window screens to keep out insectsDump or drain any standing water around the home, where mosquitoes can breedAvoid using homemade mosquito repellents, which are ineffective, according to experts.
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Publish date : 2024-09-24 08:29:00
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